Lessons from the management of acute myocardial infarction.

The National Service Framework for coronary heart disease set a number of challenging targets for the care of patients following an acute myocardial infarction. The Myocardial Infarction National Audit Project (MINAP) was devised to monitor progress and has been notably successful in winning professional support and participation and helping trusts to meet these targets. The new challenge is in translating this success to other areas of medicine. Heart failure is one such area, although it poses a number of difficulties relating primarily to disease definition and the definition of a successful outcome. MINAP was overseen by a multidisciplinary group of stakeholders, including patient organisations, and was project managed by a professionally led team at the Royal College of Physicians. Successful projects must retain confidence of all stakeholders and in part this depends on ensuring that timelines are met. Central monitoring of returns and anticipation of problems has been an important component of data completeness and quality. Next day updates to those collecting the data and more detailed quarterly reports for clinicians and chief executives within days of quarter end have been vital. Change depends on clinicians and managers working together. But most importantly, the attention to detail outlined above means the data have been believed and the resulting change for patients has been remarkable.